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BUILDING. INSPECTOR RECORD I <br />ID/SIG.SITE.WORK DATE GOMMENTS OWNER BUII,DER DEI,CARATION <br />I hereby affirrn under pmalty ofpeiury that I an exernpl liom the Contraclorc' l-icense [.aw for the following reason (Sec.7031.5 <br />Busir:ess and Profession Code): Any City or County which requites a pmnit lo conslruct. altq. iilprove, dernolish or repair any <br />stnlcture, pdor to ils issuance. also requires the applicant for such permit to frle a signed statment that he or she is licensed pursuanl <br />to the provisions of the Contraclor's Licensed Larv (Chapter 9. Conrnencing with Section 7000 of Division 3 oflhe Business ard <br />ProfcssionsCode)orthatheorsheisexernptlhqefiomandlhebasisfortheallegedexmrption. AnyviolntioDofS*tion703l-5byany <br />applicantlorapcnnitsubjectsthe applicanttoacivilpenallyofnolrnorethanfivehundreddollds($500). <br />- I. m orvner oflhe popqly. or rny ernployees rvith rvages as theii sole conpensalion. will &) th€ work ard the stnrtue is not <br />inlslded orofferedlorMle(Se.7044.BusincsandProlessionsCodcilheConlraclor-sl-icensel-awdoesnolapplyloanownerof <br />thcpropqly uhobuildsorirlprovsthqon.mdwhodo6suchuot*hitnselforherselforlhrcughhisorherou,nemployees. <br />provided that such irnp:-ovsnenls ae not intmded oroflEred fbr sale. Ii hoNevs. lhe building or improvernmt is sold rvithin one yea <br />ofcompletion. the Orvner Buildo will have the budm ofproving lhat he o she did not build or imprc\ e the prcpq1y lor lhe purpsc of <br />salc). <br />l. as orvner ofthe propsty. arn cxchrsivcly conlracting Nilh liccnsed conlractoN to conslruct lhe project (Sec. 7044. Ilusincss <br />and Profcssion Code: The Conhaclor's License [,arv does not apply to an owner ofpropeny rvho builds or irnproves lhereon. <br />an(l who contmcts for such projecls with a Contractnls) licensed pulsuant k, the Conlractor's l,icense Law). <br />I arn exernpl undq Section- - ---,. B. & P.C. for this re6on. <br />I)nlc: <br />}VORKIiRS' COIIPI'NSAI'ION <br />DOCI,ARA'IION <br />I hercby a ffirrn under penalty of pejury one of the fol lowinS declaratioN: <br />I have and rvill rnaintain a Cenificate ofConscnt to Self-lnsure for worktrs'contpensation. as provided for by Section :1700 ofthe <br />Labor Code. for the psfonnance ofthe work for which the pqmil is issued. <br />Ihaveand\\'illrnaintainrvorkers compensalioninsurance.6 requiredbySection3700oftheLahor(.ode,forthepqfonnanceof <br />the rvork for rvhich this permit is issued. My rvorko's cornpcnsalion insurancc carier and policy nurnber ae: <br />Cmier:- <br />Policl Nurnber <br />--_ <br />- Expires: <br />-l <br />certify that in the perforrnance of the work for which this pornit is issued. I shall not employ any person in any manner <br />so astobecomesubjectlotheworkss'compensationlawsofcalifomia.andagreelhatiflshouldbecomesubistlothe <br />workqs' compensation provisions ofS(tion 3700 ofthe Labor Code. I shall. forthwith cornply rvith those provisions. <br />WARNING: [iailurc to secue workos'compensation coverage is unlarvful. and an onplolcr kr o'irniral porallies and <br />civil fincs up 10 one hundred thousand dollats ($l rn k)danragcs as proviclecl for thc <br />Section 3076 of inlercsl and <br />I hcrchy affirm undcr pcnalty ofpcriury lllal I under 9 (comnlencing silh Scclion 7000) ofDiYision 3 <br />o[ lhc l]usincss and Profcssions Code. md my license is in full force ed effect ,l+.1()C <br />[,icense Clas: <br />I)atr. (4i- <br />I hereby aflitnr under pmalty ofpe{ur1 <br />issued (Sec. 1097. ('iv. C.). <br />Lender's Narne: <br />lhcre is a agency for thc pcrfounancc ollhe *'ork for \\hich this pfiilil is <br />Lender's Address: ,__, -_ <br />APPLI(AN'T DECI,ARATION <br />I hclctry allirrn under penalty ofperjuty one ofthe follou ing declarations: <br />I)enrolition Pcrmits-Asbestos Nolification Feddal Regulations ('l'itle 40. Par16) <br />Rcquhed Leller of Notifi cation <br />I cqtify that federal regulations regtrding asbesk)s removal are not applic6ble k) this preject. <br />thal rcad this application is conect. I agr€ lo comply with all Cilyand County <br />I rcpreentatives ofthis Cily and County lo cnlq ulren the[-arvs relating to <br />alreve <br />.\pplicstrl Agent <br />Prr rtrilcc ilamc <br />for inspccli()n <br />that thc <br />uJ1-,/Lq <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bfloor/VenVl nsulation <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />lnsulation/Enerqy cl <br />Drywall tz.l17/la t lWtrv-qa: <br />Ext./lnt. Lath I I at <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputv Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />,\ <br />FINAL 4/%/?P'Tltanpru t/{A)l u btr,, €f,lo,' <br />Certificate of <br />NoJes, Remarks, Etp. <br />.g)